REV-17-2603Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 570 jJ/ 9 3 SI -
City:
l `City: Miami Shores County: Miami Dad
Folio/Parcel#: Is the Building Historica
Occupancy Type: S,A1 &Ie Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): L'Merk_e_ j eitiv-/ 4%{k SL Phone#:1D,; _2)(,- y 75
Address: 7i Nr 9A St - HY
City: tat Hi S il-o4P S•
Master Permit No.
Sub Permit No.
RECEIVED
NOV 01 2017
FBC 2014
Re. -8_fl-0f- Of
€VI 7 -- a(eO
❑ EXTENSION ❑RENEWAL
CANCELLATION ❑ SHOP
DRAWINGS
13731(
NO
FFE:
e
• State: fid•
Tenant/Lessee Name: Phone#:
Email: .ei4/Ufy4�hs•,�e C.( �. r (� .t1-
CONTRACTOR: Company Name: 1 . '( "-PE )r. CO TY '
Address: 12 J +2. p. • g i C 1..412
City: IN1 , . State: FL f2, l�%
Qualifier Name: 1L 2. C.1)ac t)
Zip: 33/3 Q'
305- ZZe7o7
11C- ,z`,
Phone#: 2f/ G ••• "'V
Zip: -531g 7 -
Phone#: ` C 7.4 -4' o 3
State Certification or-Regfstr'tion #: C� � e3Q %5GY Certificate of Competency #: •
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑ Alteration
Description of Work: CO Y/Qeie. ,6/4L', /,J (s- (9I
ea/-e(A)
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
/1
I�''❑ Demolition
!�J J 1.
Specify color of color thru tile:k-';'F <s
Submittal Fee $. "IPe�mitFee $ "ir 3S CCF $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ BO. W Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE$ 4
.{- ET(
(•C�
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
•
Signature eett
OWNER o AGENT
The foregoing instrument was acknowledged before me this AA
I day of 1 ), 20 11 , by
(,46,ie f1Aa1-/3-?// 5,1c.who is personally known to
me or who has produced 1),QjiJe/S
identification and who d'
NOTA
s
P
Seal:
* * * * * * * * * * * * * * * * * * * *
APPROVED BY
(Revised02/24/2014)
L�
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of -t-}N , 20 )1 , by ° ebosetwf , who is personally known to
me or who has produced `>//vheS 215' e,UC e as
identification and who •'d take an oOFF
dif4141111/
-
NOTA
s
Pn
Seal:
******************************
Plans Examiner
CNotary Public Stats of F • ' • a
Arthur Pyle
My Commission FF 142335
pd Expires 07/16/2018
* * * * * *
************ **** *************
Zoning
Structural Review Clerk
RECEIVED
NOV 012017
R.R.C. DEVELOPMENT COMP
Serving Florida since 1977
R.R.0 Development Company
Licensed & Insured General Contractor
CCG 009564
(305) 226-8707
(305) 226-1590 (FAX)
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Miami, Florida 33182
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